GOVERNMENT OF INDIA

DIRECOTRATE GENERAL OF SUPPLIES & DISPOSALS

5, SANSAD MARG

NEW DELHI – 110 001

APPLICATION FORM

FOR

E N L I S T M E N T

WITH    DGS & D

AS

INDIAN AGENT OF FOREIGN PRINCIPAL

(Under Compulsory Enlistment Scheme of

Ministry of Finance, Deptt. of Expenditure)

APPLICATION FOR ENLISTMENT AS INDIAN AGENT OF FOREGIN PRINCIPAL
(Under compulsory enlistment scheme of Ministry of Finance, Department of Expenditure)

PART – I

( i )   NAME OF THE FIRM .......................................................
	........................................................................
( ii)	DATE OF INCORPORATION...................................................
					DD	MM	YY
(iii)   ADDRESS OF THE REGISTERED OFFICE
	
	........................................................................

	........................................................................

	.............................PIN CODE.................

	E-MAIL ADDRESS........................................

 	TELEPHONE NO..........................................

	FAX NO................................................

( iv)	ADDRESS OF THE HEAD OFFICE

	.......................................................................

	.......................................................................

	.............................PIN CODE.................

	E-MAIL ADDRESS........................................

 	TELEPHONE NO..........................................

 	FAX NO................................................

( v )	ADDRESS OF BRANCHES

ADDRESS TELEGR.ADDRESS TEL.NUMBER/FAX NO./E-MAIL ADDRESS

...............................................................................

...............................................................................

...............................................................................


( vi)	IF YOU ARE REGISTERED/ENLISTED
	WITH DGS&D, GIVE CERTIFICATE NO........................................

vii)	HAVE YOU APPLIED TO DGS&D
	FOR ENLISTMENT/REGISTRATION	.......................................
	IF SO, WITH WHAT RESULT?	.......................................

viii)	ARE YOU DOING BUSINESS WITH DGS&D
	UNDER ANY OTHER NAME		.......................................
	IF SO, GIVE DETAILS		.......................................
 

PART-II

i)	STATUS OF FIRM			1. PROPRIETORSHIP CONCERN
	PUT A (ü) MARK			2. PARTNERSHIP CONCERN
	TO WHICHEVER			3. PRIVATE LIMITED
	IS APPLICABLE			4. PUBLIC LIMITED
					5. CENTRAL GOVT. UNDERTAKING
					6. STATE OGVT. UNDERTAKING
DETAILS/STRUCTURE OF YOUR FIRM MAY BE FURNISHED AT APPENDIX ‘A’
 

PART-III

i)	ENLISTMENT REQUIRED WITH FOREIGN PRINCIPAL

	a)	NAME...........................................................
	b)	ADDRESS........................................................
		...............................................................
	c)	STORES FOR WHICH ENLISTMENT REQUIRED WITH THE FOREIGN PRINCIPAL

 	SL NO.   STORE NAME/BRIEF DISCRIPTION

	.......................................................................
	.......................................................................
	.......................................................................

	d)	IDENTIFY THE ACTUAL USERS/ORGANISATIONS WHO WILL BE
		THE CUSTOMNERS FOR THESE EQUIPMENTS: ..........................
		...............................................................

 ii)	Are you sole selling agent for the Foreign		Yes / No
	Principal (if yes, furnish copy of valid
	Agreement duly attested)
  a)	Date of appointment as sole selling agent		.........

  b)	Date up to which appointment is valid			.........

  c)	Percentage of commission				........%

  d)	If the agent has authority to commit &
	sign on behalf of the principal				Yes / No
iii)	Whether you are prepared to quote and receive
	payment in Indian Rupees.				Yes / No
 iv)	Have you facility to offer after sales service (if yes,
	give details of facilities at Appendix-“B”)		Yes / No

  v)	Have your firm/Partners/Proprietor/Directors done
	Business in the past with
	a)	DGS&D						Yes / No

	b)	Any other Govt. Deptt. (if yes, give
		details as Appendix –“C”)			Yes / No
  vi)	a)	Whether the applicant firm, Directors/Partners
	   	were at any time prosecuted for any offence
	   	by any court for civil/economic offences	Yes / No
	b) 	If yes, give details of offences and penalty.

 

 

 

 

 

 

 

Place:                                             SIGNATURE

                                                   AND NAME(               )

                                                   OF APPLICANT

                                 PROPRIETOR/AUTHORIESED PARNER/DIRECTOR

 

 

Date:

                                               (SEAL OF THE FIRM/COMPANY)